Variables and data collection
Quality indicators for complicated UTI care (dependent
variables)
Between February and November 2009 the study researcher
(VS) and a trained research assistant retrospectively collected
data from medical and nursing charts, admission
sheets, medication charts, and laboratory and culture results.
The appropriateness of antibiotic use was scored
using quality indicators (QIs) based on the treatment recommendations
from the Dutch national guideline for the
antibiotic treatment of complicated UTIs [14]. A 3-step
modified Delphi approach among experts was used to systematically
develop a set of nine QIs, which was subsequently
validated [15] (Table 1). The evidence-based Dutch
guideline comprises a general treatment recommendation
for patients with complicated UTIs, as well as recommendations
for subpopulations with special conditions, e.g.
patients with a urinary catheter and men with chronic
prostatitis. All subpopulations were included in each QI
and evaluated by their own treatment recommendation.
Men with a UTI scored also on an additional QI (‘Treat
UTI in men according to the guideline’). This QI applies to
(denominator) all men with a UTI, including those with a
chronic prostatitis, but except those with a urinary catheter.
It evaluates (numerator) whether they were treated in accordance
with the guideline regarding the empirical therapy
and treatment duration for complicated UTIs and, in
case of a chronic prostatitis, whether they were treated with
culture-guided therapy for the recommended duration.
Although local hospital antibiotic treatment guidelines
are usually based on the national guideline [14], they can
differ, e.g. because of local resistance patterns. Therefore,
the QIs concerning prescribing empirical therapy, duration
of treatment and treatment of men were scored according
to the national guideline as well as according to
the local guideline if available.